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54 Cards in this Set
- Front
- Back
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• Bean-shaped organs • Located retroperitoneally (back of peritoneum) • Adrenal gland lies on top of each kidney • Cushioned by fat and connective tissue • Capsule is a fibrous membrane cover • Hilus on the medial side • Arteries and nerves enter • Veins and ureters exit |
Kidneys |
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• Nephron is functional unit that contains 3 |
• Glomerulus • Bowman’s capsule • Tubular system |
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• Renal artery arises from the aorta • Divides into smaller branches • Each forms an afferent arteriole • Afferent arteriole divides into a capillary network: the ____
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glomerulus |
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o Outside of kidney = ___, inside = ___ |
cortex
medulla |
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o The nephron is what does all of the filtering • If nephron is damaged, then filtering will not be adequate • Kidneys are susceptible to _____ • This produces __, which are simply the waste products from the body • The nephron also reabsorbs water to the body
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atherosclerosis
urine |
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o If the arteries of the kidneys become occluded, one could experience kidney failure or kidney damage (just like an occlusion in the heart) • This is called _____ |
renal artery stenosis |
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Glomerular function • Blood is filtered by____ • Passes through _____ • Glomerular filtrate passes down tubule • Glomerular filtration rate (GFR) • Normal is ____ for a healthy individual • This is equivalent 80% of cardiac function • If the filtration is not meeting this level, something is wrong
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hydrostatic pressure Bowman’s capsule 125 mL/min |
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Tubular function: _____ • Proximal convoluted tubule: 80% of electrolytes • Loop of Henle: water • Descending loop: water, some sodium, urea, other solutes • Ascending loop:chloride, sodium • Secretion
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Reabsorption |
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kidney • ____ production through secretion of _____ • If kidneys fail this will not happen • Pt will suffer _____, and oxygenation problems (SOB) because O2 is carried on RBCs • The pt will put out urine that doesn’t have the waste products filtered out • Pt will require ____ and be fatigue
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Red blood cell (RBC) Erythropoietin anemia dialysis |
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Kidneys • Blood pressure regulation • _____ is secreted • When BP drops, this is released which goes to the lungs which produces angiotensinogen which converts to angiotensin. This constricts vessels. Thus increasing BP • If this doesn’t happen, filtration/ urine formation decreases • Renin activates angiotensinogen to angiotensin • Angiotensin I is converted to angiotensin II by ACE • Angiotensin II stimulates the release of aldosterone
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Renin |
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Ureters • Join the renal pelvis at the _____ • Join the bladder at the _____ |
ureteropelvic junction (UPJ)
ureterovesical junction (UVJ) |
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• Bladder • Serves as a _____ with a Capacity: _____ • Trigone (bladder is in triangular shape) • Bladder muscle (detrusor) • This muscle can weaken. (decreasing capacity, and increasing incontinence) • Urination, micturition, voiding
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reservoir for urine 600 to 1000 mL |
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• _____: Extends from bladder neck to external meatus • Conduit for urine during voiding • Length • Female: ____ • Male: _____
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Urethra 1–2 inches (3–5 cm) 8–10 inches (20–25 cm) |
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____: Formed by bladder, urethra, and pelvic floor muscles • Voluntary control of this unit is defined as _____ • ____ of the bladder stimulates stretch receptors • Impulses sent to brain
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Urethrovesical unit continence Distention |
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Between ages 30 and 90 • Size and weight of kidneys decrease ____
By seventh decade • Loss of ____ of glomerular function
• ____ accelerates the decrease of renal size with age
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20% to 30%
30% to 50%
Atherosclerosis |
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____ of urine is what is normal per hour. |
Greater than 60mL |
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To palpate the kidneys, they are felt along the back in the CVA angle. However kidneys should not be able to be felt.
Percussing the hand on the back (CVA angle) is done to check for pain. If acute pain is felt, then ____ |
it is kidney problems. Otherwise it is musculoskeletal |
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Urine studies: Urinalysis • When? ____ • Examine urine _____ • If this cant be accomplished, it should be ____ |
First morning void
within 1 hour
put in the fridge (do not warm it) |
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Creatinine clearance • Collect ___ specimen (urine is on ice to stay “fresh” until total collection is finished) • If pt uses toilet/ flushes, ____ • Only the first void of the whole collection is _____ • Creatinine clearance closely approximates ____ |
24-hour urine must start over thrown out. GFR |
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Females are cleaned ____. Collect specimen ____. (Spread ___) |
front to back
midstream
labia |
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If female says she is peeing blood, ____ (possible cause) |
check for menstruation first |
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• _____Looking up urethra and into the bladder • NPO is NOT necessary, but informed consent is • A complication of cystoscopy is bladder damage/ tear • Must monitor for blood after procedure, though pink tinged blood is normal • Fentanyl is used for conscious sedation
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Cystoscopy |
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Cystoscopy • Indications: _____ |
hematuria (bright red blood is close to the exit [urinary bladder and below][could indicate bladder cancer]), (darker blood is further away from exit [above urinary bladder]) |
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____: Chronic, painful inflammation of the bladder • Cause unknown – not associated with UTIs • More common in ____ • This is called ____ • No cure, but there is treatment
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Interstitial Cystitis women painful bladder syndrome |
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Interstitial Cystitis Clinical Manifestations – Moderate to severe pelvic ___3___ – Exacerbated by ___5___, etc. • Patient should ___2___
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pain, frequency, urgency
full bladder, delayed urination, sexual intercourse, physical exercise, stress
wear loose fitting clothes, use lube with sex |
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Interstitial Cystitis Eliminate foods/beverages known to irritate bladder wall: __6__ |
caffeine, alcohol, fruits, citrus products, nuts, foods containing vinegar |
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Interstitial Cystitis • Stress management • ___ during sexual intercourse • __2__ – used to relieve burning pain and urinary frequency • Urinary diversions, other medications • Teach patient to avoid ____ • Teach patient to avoid clothing that creates ____
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Lubricants Amitriptyline, Noretriptyline high-potency vitamins suprapubic pressure. |
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____: Sclerosis of the small arteries and arterioles r/t atherosclerosis and hypertension • Leads to decreased blood flow in the kidney • Kidney unable to obtain __2__
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Nephrosclerosis
oxygen and nutrients |
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Nephrosclerosis Treatment: ___ |
– Antihypertensives |
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Nephrosclerosis
Complication:___ |
– renal insufficiency which can lead to renal failure if left untreated |
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Renal Artery Stenosis: ____ • Related to atherosclerosis • Can cause ____
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Partial occlusion of one or both renal arteries and their major branches
hypertension |
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Renal Artery Stenosis: ____ – best diagnostic tool • Goal of therapy – __2__ • ____ – opens clogged arteries
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• Renal arteriogram
Control BP and restore tissue perfusion
Renal Angioplasty |
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________: Hereditary. •Both kidneys involved • Kidneys full of cysts (sores) – blood or pus filled – These can rupture and leak blood/ pus into kidney • Cysts enlarge – destroys surrounding healthy tissue • This leads to a lot of _____
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Polycystic Kidney Disease
renal failure |
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Polycystic Kidney Disease Clinical Manifestations 4
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• Chronic abdominal, back, or side pain – r/t enlarged kidney • Hypertension • Hematuria – r/t ruptured cysts • Feeling of pelvic heaviness |
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•_____ – best diagnostic tests for Polycystic Kidney disease |
Ultrasound or CT scan |
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Polycystic Kidney Disease Treatment • No specific treatment • Teach patient how to prevent or reduce UTIs • ____:removal of kidney • _____ to control BP • Dialysis
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Nephrectomy
Antihypertensives |
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Polycystic Kidney Disease Complications • Liver, heart, intestines, brain can become affected • Usually leads to _____
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ESKD End Stage Kidney Disease |
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Chronic Kidney Disease (CKD) • Involves __2__ of kidney function • ____ are most prone to this because they are prone to HTN and Diabetes
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progressive, irreversible loss
African Americans |
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• Leading causes of ESKD ____: Hyperglycemic blood forms plaques inside any blood vessel-reducing blood flow and increasing HTN • ___ is largely decreased and the waste products do not leave the body • _____ • Both diabetes and HTN can usually be controlled but not cured
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Diabetes
Filtration rate
Hypertension |
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____:Results from inability of kidneys to concentrate urine • Occurs most often at night • Patient will have to get up several times a night to pee • Specific gravity (concentration of urine) is decreased and fixed around 1.010 |
• Polyuria |
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• Urine output lower than 40 mL per 24 hours |
Anuria |
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________ • Not only from kidney failure but also from protein intake, fever, corticosteroids, and catabolism • N/V, lethargy, fatigue, impaired thought processes, and headaches occur |
BUN level ↑ |
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Defective carbohydrate metabolism • Patients with diabetes who develop uremia may require _____ after onset of CKD • Excretion of insulin dependent on kidneys
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less insulin |
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• Hyperkalemia (cant leave the body): Most serious electrolyte disorder in kidney disease. Fatal dysrhythmias • May be lowered by ___ (binds to potassium in GI tracted to be excreted in feces) or ___ (which causes K+ to go back in cell and out of blood stream)
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Kayexalate
insulin |
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• Sodium: Because of impaired excretion, sodium is retained. Water is retained as exhibited by __3___ |
• Edema • Hypertension • CHF |
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____ is a buffer secreted by the kidneys. If kidneys are failing, it will not be secreted |
Sodium bicarbonate |
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• ____: inadequate oxygenation is at the tissue level (worse than the other)
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Hypoxia |
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• ____: this is at the cellular level (in the blood stream) |
Hypoxemia |
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____ is a late sign of inadequate oxygenation. |
Cyanosis |
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Respiratory system • Patient has metabolic acidosis – respiratory system will try to compensate • The breathing becomes – rapid, deep and labored – to blow off co2 (acid). This is known as ____
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• Kussmaul respirations |
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_____: Expected as renal failure progresses • Attributed to • ↑ Nitrogenous waste products • Electrolyte imbalances • Metabolic acidosis • Atrophy • Demyelination of nerve fibers |
Neurologic system dysfunction |
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• Dyslipidemia • Goal: Lowering LDL level below 100 mg/dL, Lowering triglyceride level below 200 mg/dL • _____: Most effective for lowering LDL level |
HMG-CoA reductase inhibitors (Statins) |
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Begun when patient’s uremia can no longer be adequately managed conservatively |
Dialysis |
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• ESKD treated with dialysis because 3 |
There is a lack of donated organs Some patients are physically or mentally unsuitable for transplantation Some patients do not want transplants
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